Wed August 7, 2013

Will Changing Cancer Terminology Change Treatment?

This is TELL ME MORE from NPR News. I'm Michel Martin. Later in the program, we'll talk with Hall of Fame football player Cris Carter. We'll talk about overcoming struggles in his career to reach the top of the game and his new book, "Going Deep." That's in just a few minutes. But first, we're going to talk about your health, and if you've ever been involved with cancer or know someone who has, then you know that it's one of the most frightening diagnosis someone can get. After that initial shock, there can be grueling rounds of treatment. But it turns out that sometimes no treatment is needed at all, and that's why the National Cancer Institute recently recommended that the definition of cancer be changed.

The National Cancer Institute is the main government agency for cancer research. Their new definition of cancer would be narrower than current standards. The Institute hopes that keeping the word cancer out of some diagnoses would minimize unnecessary treatments and help calm patient anxiety. We wanted to talk more about this so we've called Dr. Otis Brawley. He's the chief medical officer for the American Cancer Society. That's a separate organization dedicated to eliminating cancer. And he's with us via Skype from Lyon, France. Welcome, thank you so much for joining us.

OTIS BRAWLEY: Thank you. How are you today?

MARTIN: Great. So where is this recommendation to change the definition of cancer coming from? Why is this happening, and why now?

BRAWLEY: Well, the National Cancer Institute got a group of very smart experts in the area to sit down and there was actually a series of meetings to look at all of this and they came up with these recommendations. Essentially, what has happened is our technologies have gotten so good that we can find some early cancers, or things that look like cancer, that we now know, if left alone, would never grow, spread and harm the patient. So we're actually treating some lesions that look like cancer unnecessarily.

MARTIN: Why is this necessary to change the terminology?

BRAWLEY: Well, for example, I, personally, in my own practice, have had a gentleman who had a gleason - low-grade prostate cancer with very low volume. And given his age, which was in his 70s, it's something that almost all doctors agree should be watched as opposed to treated. This gentleman had tremendous difficulty with the fact that he has cancer and we're going to watch it as opposed to cut it out. This gleason, 3+3 prostate cancer, perhaps we shouldn't be calling it prostate cancer - we should call it something else, 'cause it actually rarely ever causes any harm.

MARTIN: Is the main benefit of changing the terminology changing the way doctors talk to patients about it?

BRAWLEY: Yeah. What we're trying to do is spare some people the harms associated with unnecessary treatment. And there's a lot of people who are demanding unnecessary treatment, there's a lot of doctors who don't understand that every cancer is not highly aggressive and there's a wide spectrum of cancers. Helping those doctors understand, helping the patients understand.

MARTIN: Dr. Brawley, as you probably know better than anybody, one of the other issues in the way cancer is treated in the United States is that different cancers affect different people differently, different groups differently, and that different groups tend to interact with the medical establishment differently. Right?

BRAWLEY: Absolutely...

MARTIN: ...So one of the concerns I think that some people have is that there are some groups that are undertreated now, that don't get as aggressive treatment now even when they need it. According to the Centers for Disease Control, for example, of all men, new cancer cases and cancer death rates are highest among black men. Among women, cancer death rates are highest among black women. And we know that there are certain cancers in which African-American women get them less frequently, but when they get them, they are more likely to die. And some people look at that and think, maybe there's a genetic component but could there be a treatment component to that?

BRAWLEY: Oh, there is definitely a treatment component when we look at the black-white differences, but you're absolutely right. We live in a world where there's a group of people who don't need as much treatment, but are getting far, far too much treatment, and there's a group of people who need treatment and don't get it.

MARTIN: So how would changing this terminology affect that situation or do you think that it would? I mean, do you have any concern that changing this diagnosis, even if it has beneficial effects for some groups, might actually harm other groups who are already undertreated?

BRAWLEY: Well, I'm hoping that we're going to be able to mold our treatments to the individual. The era of personalized medicine, where we can say, Mrs. Smith, you have a breast cancer and this is the kind of breast cancer that, if left alone, will kill you. Therefore, you need to be treated. We can say, Mrs. Johnson, you have what looks like a breast cancer, but our genomic studies, which are more advanced, tell us that this is the kind of tumor - it's very small right now and it's going to stay small for the next 60 years. It is never going to harm you.

MARTIN: Overall, Dr. Brawley, before we let you go - and thank you for taking the time while you're kind of in the middle of doing your important work - do you feel that, overall, that this signals a change in the way we are thinking about cancer? I know we've talked to you earlier about some of the changes in the protocols, or the recommended changes in protocols, for some routine screenings out of the sense that some of these routine screenings actually lead to more harm than good by encouraging people to get treatment that they don't need and so forth. Do you feel that, overall, are we changing the way we talk about and think about cancer, and is that - are we moving in the right direction?

BRAWLEY: I do believe we're moving in the right direction. We are changing the way we think about a lot of cancers. In the case of prostate cancer, for both black and white men, we're realizing that about half to 60 percent actually should be watched instead of treated. We're going to find out the guys who really need treatment to treat them. In the case of breast cancer, it's about a third of women with localized breast cancer have tumors that really would never bother them.

We're going to develop better tests to figure out which ones need to be watched versus treated. We don't have those tests right now. In the case of thyroid cancer, it's again, 20 to 30 percent of cancers that really need to be watched instead of treated. And same is true for lung cancer, smaller proportion, maybe 10 percent. But this is an improvement. This is actually science evolving and we're going to spare a lot of people needless treatment and the needless harm from that treatment.

MARTIN: Dr. Otis Brawley is the chief medical officer for the American Cancer Society, and he was with us from Lyon via Skype. Thank you so much, Dr. Brawley, for speaking with us.